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Seizure outcome in children treated for arteriovenous malformations using gamma knife radiosurgery
P C Gerszten1, P D Adelson, D Kondziolka
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pa., USA.
Insights
Pediatric arteriovenous malformation (AVM) patients treated with radiosurgery achieved good seizure control. Most children became seizure-free, demonstrating radiosurgery
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Radiation Oncology
Background:
- Arteriovenous malformations (AVMs) are a significant cause of seizures in children, second only to epilepsy.
- Radiosurgery offers a safe and effective treatment for pediatric AVMs, but its impact on seizure control remains understudied.
- Understanding seizure outcomes post-radiosurgery is crucial for optimizing treatment strategies in pediatric AVM patients.
Purpose of the Study:
- To evaluate the efficacy of gamma knife radiosurgery in controlling seizures associated with arteriovenous malformations in children.
- To determine the long-term seizure outcomes in pediatric patients following radiosurgical treatment for AVMs.
- To identify factors influencing seizure control after radiosurgery for pediatric AVMs.
Main Methods:
- Retrospective analysis of 72 pediatric patients (<18 years) treated with gamma knife radiosurgery for AVMs between 1987 and 1994.
- Detailed review of seizure types, lesion characteristics (location, Spetzler-Martin grade), and treatment outcomes.
- Follow-up assessment of seizure status and anticonvulsant medication use post-radiosurgery.
Main Results:
- Fifteen patients (21%) presented with seizures; the majority were generalized tonic-clonic or focal motor/sensory.
- After radiosurgery, 85% of patients with pre-existing seizures became seizure-free and discontinued medication (mean follow-up 47 months).
- Seizure outcome was independent of lesion location or complete obliteration; only 3% developed new-onset seizures post-treatment.
Conclusions:
- Stereotactic radiosurgery is an effective non-invasive treatment for pediatric AVMs, yielding favorable seizure control.
- Radiosurgery provides a good outcome for both AVM management and associated seizure reduction in children.
- The findings support radiosurgery as a valuable therapeutic option for pediatric AVMs presenting with seizures.
Abstract:
Seizures are the second most common presenting symptom of arteriovenous malformations (AVMs) in children. Although radiosurgery has been found to be a safe and effective alternative treatment, the outcome of seizure control in children after radiosurgery for AVMs is unknown. Between 1987 and 1994, 72 children under the age of 18 years were treated with gamma knife radiosurgery for AVMs at our institution. Fifteen patients (21%) had seizures as part of their clinical course. There were 11 boys and 4 girls with ages varying from 2 to 17 years (median 16 years). Seizures included: generalized tonic-clonic (n = 8); focal motor or sensory (n = 4); partial complex (n = 2), and a combination of generalized and partial complex (n = 1). Nine lesions were in cortical locations; six were subcortical. Spetzler-Martin grades included: II (n = 7); III (n = 4); IV (n = 2), and VI (n = 2). During follow-up after radiosurgical treatment, 11 of 13 patients (85%) were seizure free and off anticonvulsant therapy (mean follow-up 47 months). Two patients had a significant improvement in their seizures but continue on medication. Two of the 72 patients (3%) developed seizures after treatment and remain on medication. Seizure outcome was not associated with the location or complete obliteration of the lesion. We conclude that stereotactic radiosurgery, as a non-invasive alternative, is associated with a good outcome for the AVM as well as AVM-related seizures in children.